[Show abstract][Hide abstract] ABSTRACT: To evaluate the effect of temporary stent graft placement in the treatment of benign anastomotic biliary strictures.
Nine patients, five women and four men, 22-64 years old (mean, 47.5 years), with chronic benign biliary anastomotic strictures, refractory to repeated balloon dilations, were treated by prolonged, temporary placement of stent-grafts. Four patients had strictures following a liver transplantation; three of them in bilio-enteric anastomoses and one in a choledocho-choledochostomy. Four of the other five patients had strictures at bilio-enteric anastomoses, which developed after complications following laparoscopic cholecystectomies and in one after a Whipple procedure for duodenal carcinoma. In eight patients, balloon-expandable stent-grafts were placed and one patient was treated by insertion of a self-expanding stent-graft.
In the transplant group, treatment of patients with bilio-enteric anastomoses was unsuccessful (mean stent duration, 30 days). The patient treated for stenosis in the choledocho-choledochostomy responded well to consecutive self-expanding stent-graft placement (total placement duration, 112 days). All patients with bilio-enteric anastomoses in the non-transplant group were treated successfully with stent-grafts (mean placement duration, 37 days).
Treatment of benign biliary strictures with temporary placement of stent-grafts has a positive effect, but is less successful in patients with strictures developed following a liver transplant.
Korean journal of radiology: official journal of the Korean Radiological Society 11/2011; 12(6):708-13. · 1.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Positron emission tomography (PET) has seen an increasing clinical utilization in the last decade, such that it is now a standard oncology imaging modality. Its success is based on the detection of altered fluorine-18 fluorodeoxyglucose (18F-FDG) biodistribution, reflecting glucose transport/metabolism in malignant tumor tissues. Integrated PET/computed tomography cameras combine functional and anatomical information in a synergistic manner that improves diagnostic interpretation, and newer positron-emitting radiopharmaceuticals have been developed to expand the application of non-FDG PET imaging. The increasing use of cross-sectional imaging procedures has led to a more frequent detection of incidental adrenal masses. Although conventional imaging modalities such as computed tomography and MRI can characterize the majority of these lesions, 18F-FDG PET has been reported as a useful tool to distinguish benign from malignant etiologies in indeterminate adrenal masses. Although 18F-FDG PET has enjoyed success in staging a wide range of cancers, including detection of adrenal metastases and evaluation of adrenocortical carcinoma, it has had limited impact for the evaluation of neuroendocrine tumors. Positron-emitting amine precursor and somatostatin analogs have been validated in research settings to provide accurate imaging of enterochromaffin and chromaffin neuroendocrine tumors and medullary thyroid cancer. The aim of this review article is to provide an overview of the role of 18F-FDG and newer positron-emitting radiopharmaceuticals in the evaluation of adrenal and neuroendocrine tumors.
Nuclear Medicine Communications 09/2011; 32(9):764-81. · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Primary thyroid lymphoma is an uncommon neoplasm frequently associated with lymphocytic thyroiditis (LT). Once the pathologic diagnosis of primary thyroid lymphoma is established, imaging plays an important role in tumor staging and evaluating treatment response. The present case discusses the role of fluorodeoxyglucose positron emission tomography (18F-FDG PET)/computed tomography (CT) in this clinical setting along with the potential diagnostic challenges.
A 44-year-old man with a history of LT and hypothyroidism presented with an enlarging goiter. Initial imaging evaluation showed markedly enlarged gland with bilateral cervical and mediastinal adenopathy. Histopathologic evaluation confirmed the diagnosis of primary thyroid lymphoma on a background of LT. An 18F-FDG PET/CT revealed increased uptake in the gland and lymph nodes. Follow-up 18F-FDG PET/CT after chemotherapy showed interval decrease in FDG uptake in the thyroid gland associated with interval decrease in the size and metabolic activity of the cervical and superior mediastinal lymph nodes.
The frequent association of LT with primary thyroid lymphoma and the overlap of their clinical and pathologic findings pose a significant diagnostic challenge. While other imaging techniques are helpful in evaluating anatomic local and regional extent of primary thyroid lymphoma, 18F-FDG PET/CT can be of an added value in evaluating its metabolic activity and detecting regional and distant disease as well as in assessing response to treatment.
Thyroid: official journal of the American Thyroid Association 08/2011; 21(10):1153-6. · 2.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present report describes two cases of chronic lower gastrointestinal bleeding caused by systemic-to-mesenteric venous collateral vessels resulting from longstanding inferior vena cava obstruction. They were successfully treated with caval balloon angioplasty and stent placement. No recurrent bleeding was seen at 15 and 24 months of follow up, respectively.
Journal of vascular and interventional radiology: JVIR 07/2011; 22(7):1035-8. · 1.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Incidentally discovered adrenal masses are commonly seen with high resolution diagnostic imaging performed for indications other than adrenal disease. Although the majority of these masses are benign and non-secretory, their unexpected discovery prompts further biochemical and often repeated imaging evaluations, sufficient to identify hormonally active adrenal masses and/or primary or metastatic neoplasms to the adrenal(s). In the present paper we investigate the role of PET and PET/CT for the detection of adrenal incidentalomas in comparison with CT and MRI.
a systematic revision of the papers published in PubMed/Medline until September 2010 was done.
The diagnostic imaging approach to incidentally discovered adrenal masses includes computed tomography (CT), magnetic resonance imaging (MRI) and more recently positron emission tomography (PET) with radiopharmaceuticals designed to exploit mechanisms of cellular metabolism, adrenal substrate precursor uptake, or receptor binding.
The functional maps created by PET imaging agents and the anatomic information provided by near-simultaneously acquired, co-registered CT facilitates localization and diagnosis of adrenal dysfunction, distinguishes unilateral from bilateral disease, and aids in characterizing malignant primary and metastatic adrenal disease.
European journal of radiology 02/2011; 81(3):441-50. · 2.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We present a case of acute renal artery occlusion caused by a high-grade stenosis associated with in-situ thrombosis. Endovascular renal artery stent placement combined with catheter-directed thrombolysis reversed the renal ischemia with restoration of renal function despite the prolonged ischemia.
Journal of clinical imaging science. 01/2011; 1:11.
[Show abstract][Hide abstract] ABSTRACT: The present report describes the safe retrieval of caudally migrated optional inferior vena cava (IVC) filters with significant IVC penetration. Three patients had optional IVC filters placed for deep vein thrombosis/pulmonary emboli and contraindications for anticoagulation. Subsequent imaging showed caudal migration and penetration of the filter legs through the IVC wall. All filters were removed without major complications. One patient experienced abdominal pain after filter removal, which required no treatment. Caudal migration of optional filters with IVC wall penetration by the filter legs may be more common with new filter designs in which the secondary and primary struts are separated.
Journal of vascular and interventional radiology: JVIR 06/2010; 21(6):923-6. · 1.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This report describes two cases of successful treatment of an internal iliac artery aneurysm (IIAA) type II endoleak utilizing a percutaneous transosseous access that could not be treated using an endovascular or standard percutaneous approach. A direct percutaneous approach through bone was chosen to avoid vital structures and the surrounding bowel. The procedure was successful and required minimal fluoroscopy time compared with other treatment options. We believe this procedure is an alternative to some of the more complex and technically challenging means of treating this lesion.